A Woman's Guide To Asthma

Jessica Iucciolino just breathed. With each gulp, the debris-laden air moved seamlessly into the 25-year-old's lungs, then slipped silently out again. Her chest rose effortlessly up and down, in and out, in an easy, essential rhythm most people take for granted—but not Iucciolino. "It was amazing and truly unbelievable," she says now.

It was September 11, 2001. Iucciolino, a police officer and a woman with asthma, was at Ground Zero.

Her asthma was totally under control, even at Ground Zero. It still is.

Ground Zero Air

For many desperate hours after the World Trade Center collapsed, the dense plumes of smoke that raced down New York City's broad avenues rained white ash, debris, and asbestos-laced dust onto police and rescue workers. Iucciolino, who walked a beat in Brooklyn at the time, was one of them.

When she arrived that night, the stubs of the towers were still burning. Dust and debris lay an inch-and-a-half thick on the ground. You could both see and smell the air. Like everyone in Manhattan that day, Iucciolino was afraid—but not for all the same reasons. Three years earlier, while at law school, Iucciolino had developed a cough she just couldn't shake. "It came with the constant colds I started getting during the winter," she recalls. "I thought both were stress related, so I sort of ignored them for awhile." Then she also started feeling a tightness in her chest. It was the combination that finally sent her to the doctor, who gave her a pulmonary-function test to measure the ability of her lungs to move air in and out—and diagnosed asthma.

Asthma?

"I was floored. I mean, I thought asthma was a children's disease—and I was incredibly worried that I'd never be able to exercise or do anything physically demanding again," says Iucciolino, who even then aspired to be a cop. Unfortunately, her worst fears were realized just after her diagnosis, when she had a tough time simply climbing a flight of stairs. "I pretty much limited myself to studying and staying home," she says. "I didn't want to do anything physically to precipitate an attack. And I didn't like going out because I didn't want to expose myself to cigarette smoke."[pagebreak]

Saved by Her Meds

Surprising, isn't it? The smoke of even a hundred unfiltered Camels couldn't compare with the thick, venomous air Iucciolino encountered at Ground Zero. Yet thanks to daily medication to reduce both airway constriction and inflammation—the two hallmarks of the disease—Iucciolino didn't have the kind of respiratory problems hundreds of others on the scene later developed (a condition referred to as "World Trade Center cough").

"After 3 years of searching for the right medication in the right combination with stress relief and physical activity, such as yoga, to maintain my lung capacity, I was very protected," she says. "My asthma was totally under control. And still is."

Not Child's Play

More than 14 million Americans have asthma. Of these, almost 5 million are children. The rest—more than 9 million—are adults, some of whom, like Iucciolino, didn't have the disease as children. In fact, of those diagnosed in adulthood, the majority are women.

"Most people don't tend to think of asthma as a women's issue. But it really is," says Kathleen A. Sheerin, MD, an asthma specialist in private practice with the Atlanta Allergy and Asthma Clinic, and founder of the nonprofit asthma-education group, Breathe Georgia. In fact, studies are just beginning to reveal real differences in the male and female experience of asthma, despite the fact that asthma, in both the sexes, is caused primarily by inflammation in the airways, a seemingly gender-neutral problem. Yet not only do more women than men have asthma, women with asthma tend to experience more discomfort than men with asthma who have the same degree of airway obstruction. And as a result, they report more symptoms, take more drugs, and seek more health care than men with the same disease.

For instance, one recent study at the Yale-New Haven Hospital found that high-risk female patients were admitted twice as often as high-risk males and tended to have longer admissions (5 days for women versus 4 days for men—even though the women, in general, didn't appear to be as sick as the men when they arrived at the ER. Scientists aren't sure why there's such a disparity. But studies suggest that, in part, the excess burden of asthma in women may be due to hormones.[pagebreak]

"In childhood, asthma is more common in boys than girls," points out asthma specialist Carlos Camargo, MD, DrPH, assistant professor of medicine and epidemiology at Harvard University and the national spokesperson for Asthma Action America, a new national education campaign committed to improving asthma care in the US. "But between the ages of 10 and 15—during puberty and its accompanying hormonal surges—the number of girls who develop asthma starts to exceed the number among boys. The trend continues through adulthood, and most scientists believe that hormones are behind it. Some women may have a sort of sensitivity to estrogen and progesterone that ends up giving them asthma."

There are other theories too, but one thing we absolutely know about asthma is that once you have it, you always have it—though you don't have to be at its mercy. "Thanks to the widespread use of inhaled corticosteroid medication over the past 15 years, asthma is absolutely controllable," says Dr. Camargo, "if you're conscientious about controlling it." Trouble is, says Dr. Camargo, as many as half of all adults with asthma are not.

Waiting to Inhale

No traitor to my gender, I'm going to begin this part of the piece with an excuse: Asthma is a tricky disease. Its components—inflammation (airway swelling) and bronchoconstriction (tightening of the muscles surrounding the bronchioles, or airways)—are pretty straightforward.Both cause your airways to narrow, making it tough to breathe. Common symptoms include coughing, wheezing, shortness of breath, and chest tightness. Typical triggers include cigarette smoke, dust mites, animal dander, indoor mold, cold air, exercise, viral upper respiratory infections such as colds, and strong odors such as gasoline fumes, perfume, hair spray, and paint. Not so hard, right?

But here's the tricky part: Asthma doesn't go away when its symptoms go away. Asthmatics often have to take medication every day for many years to suppress the disease's root cause. And when they do, they have to remain committed to taking their medicine even when they're not feeling ill. And that can be, well, tricky—even for people who fully understand the need for the medication. Like nurses.

In one study, Dr. Camargo found that even among nurses with asthma, nearly half of those with mild or moderate asthma neglected to take their medication consistently. And that was the good news: Of those with severe persistent asthma, just 32 percent took their meds correctly and consistently.

To be fair, men with asthma have just as much trouble as women adhering to their treatment plans. But more women have asthma, and many may also be caring for children with the disease. Asthma tends to run in families, and there's evidence that a maternal history of asthma confers a higher risk for the disease than a paternal history. So the burden—and the need to treat—is greater.[pagebreak]

For Women Only

Catching Your Breath So, here's where to begin—with the following five for-women-only steps guaranteed to help you stay on top of your asthma, or even prevent the disease from developing in the first place. Discuss these with your doctor to decide which ones will work best for you.

Know your cycle—and your disease. Hormonal fluctuations during the month, often prior to ovulation or near menses, can cause symptoms to worsen in some women. For some women, it's other times during their cycle. Talk with your doctor about creating a plan of attack—such as using some meds more often—especially for those days. Be sure to mention if you're taking aspirin or nonsteroidal anti-inflammatories such as ibuprofen for menstrual cramps, because those drugs can make asthma worse.

Maintain a healthy weight. Studies have shown that weight loss after age 18 is linked to a reduced risk of developing asthma, while weight gain after 18 is linked with an increased risk. The link is strong and more pronounced in women than men, says Dr. Camargo. It may be because extra weight in women is associated with higher levels of potentially asthma-inducing estrogen.

Take your meds—even when you're pregnant. A third of women with asthma who get pregnant say their asthma improves during their pregnancy, a third say it worsens, and a third say it stays the same. "What this statistical grab bag is telling us is that the link between hormones and asthma isn't at all clear-cut," says Dr. Camargo. But uncontrolled asthma may be more harmful to a fetus than asthma that is controlled with daily medication—especially inhaled medication, which affects a fetus less than oral medication. "In fact, babies born to mothers who routinely have difficulty breathing can suffer very serious complications, including fetal growth retardation, premature birth, low birth weight, and low Apgar scores," explains Dr. Sheerin. (Apgar scores are ratings every newborn gets at 1 and 5 minutes after birth to measure heart rate, breathing, muscle tone, reflexes, and color.) "They, like their mothers, may not be receiving the oxygen they need to thrive."

Weigh all the risks when considering hormone therapy (HT). Studies have shown that HT can significantly boost the risk of developing asthma in some women. Talk to your doctor if you're taking HT and have been plagued by multiple bouts of bronchitis or a cough you just can't seem to shake.

Protect your bones even as you're preserving your breath. Oral corticosteroids, used to treat asthma, can inhibit calcium absorption and bone formation and increase calcium loss from the kidneys, which can leave you susceptible to osteoporosis. Inhaled corticosteroids, the most effective treatment we now have for asthma, are a much safer approach. One study suggested that, at lower doses, inhaled corticosteroids do not cause osteoporosis. Talk to your doctor about switching. [pagebreak]

Is It Asthma?

Plagued with frequent colds, coughs, or bronchitis? You may want to lay off the OJ and consult an MD—you could have asthma.

To find out, simply assign "yes" or "no" to the following statements, adapted in part from a quiz by Asthma Action America. (Kathleen Sheerin, MD, contributed the first item to this quiz.)

You're a nonsmoker, and you tend to develop "bronchitis"—a diagnosis sometimes used by doctors as a euphemism for asthma—three or four times a year, causing you to wheeze or have a hard time breathing.

A persistent cough frequently wakes you up at night.

Your "bronchitis" frequently forces you to miss work or affects your ability to get things done on the job or at home.

You routinely experience tightness in your chest or coughing fits while exercising or doing anything even remotely physical, such as walking up a flight of stairs.

You often find it more difficult to breathe in very cold or very hot weather.

If you responded "yes" to any statements, you could have asthma. To find out, make an appointment with your physician to talk about your symptoms, what triggers them, and whether asthma runs in your family. Ask for a lung-function test (don't worry, it's painless) to receive an objective measure of how well your lungs are working.

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